Laos’s Rural Women Await Midwives

BANGKOK, Jul 31 2012 (IPS) - A year after the Laotian government launched a safe pregnancy programme news of this initiative, involving the dispatch of teams of midwives across the country, is yet to reach women in the remote communities.

A 30-year-old mother of three from the Akha ethnic minority in the Baan Monlem village of the northern province of Bokeo told Mona Girgis, director of Plan International’s local office, that she has never heard of the National Skilled Birth Attendance programme.

But, Girgis told IPS, the woman who identified herself as Noi welcomed the prospect of trained midwives coming to her village to support women in their pregnancies and deliveries.

Noi’s community of 60 families, that makes a living by growing rice on the hilly slopes of Bokeo, currently depends on the experience of older village women rather than a skilled birth attendant or midwife.

The situation of pregnant women in Baan Monlem is true for most other rural communities in Laos. A majority of the country’s 6.5 million people live in rural communities scattered across this mountainous Southeast Asian nation, and over 80 percent of the women give birth at home, according to studies by the United Nations Population Fund (UNFPA).

Laos’s mountain communities include some 100 ethnic minorities, forming one-fourth of the population and contributing heavily to the country’s high maternal mortality ratio (MMR) of 470 deaths per 100,000 live births.

Laos currently has the worst national record in Asia, topping even war-torn Afghanistan which has a MMR of 460 for every 100,000 live births, according to ‘Trends in Maternal Mortality: 1990-2010’, a study by the World Bank, World Health Organisation and UNFPA released this year.

“Families living in remote ethnic communities are usually very poor, and do not have the financial resources to pay for transport or fees to receive (health care) services,” explains Girgis.

“I have frequently heard this from women in different parts of Laos,” Girgis said. “We are aware that there are other obstacles, such as the condition of roads, language barriers and awareness of the need to seek medical care,” she added.

Lack of professional help has resulted in an average of two women dying every day in Laos from pregnancy-related complications and childbirth, notes the UNFPA in a report. “For every woman who dies many more suffer from illnesses or disability from complications during pregnancy and childbirth.”

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It was to overcome Laos’s notoriety as the most dangerous place in Asia for a woman to give birth that drove Vientiane to aggressively advance the cause of safe pregnancies.

June saw 80 midwives graduate from a special programme shaped by the ministry of health, international donors and the UNFPA. This second graduating class added to the initial group of 140 midwives who qualified last year, pioneering a professional cadre of community midwives in the communist-ruled country.

The programme received a shot in the arm when the government declared June as the “Month of Midwives,” going beyond just the one day, on May 5, when the world annually marks the International Day of Midwives.

“Every community needs to have its own professional midwife to work with community leaders, families,individual women and adolescent girls to improve knowledge of safe pregnancy, childbirth and care of mothers and babies after birth,” Som Ock Kingsada, vice-minister of health, was reported saying at an event to mark the special month.

The current midwives training programme comes after a lapse of two decades during which no midwives were produced in the country. It has a curriculum that addresses a national weakness – low use of health facilities.

“We had to build in a lot of skills with laboratory work as trainees have limited access to cases, given the low utilisation of health facilities,” says Della Sherratt, international programme coordinator for skilled birth attendance at the Laos office of UNFPA.

“They are required to do a lot of hands on practice and case loads, as would be expected in other countries, (and) we have to send them to clinical areas with some exposure first,” Sherrat said.

And as the community midwives programme forges ahead, focus is shifting to more professional care in isolated communities in the mountainous areas and rural lowlands. “We are focusing this year on those areas where there are no health workers,” Sherrat told IPS.

These efforts are expected to help Laos meet one of the targets in the United Nations Millennium Development Goal of reducing MMR by 75 percent between 1990 and 2015.

According to the World Bank, women dying while giving birth represents a “determinant of poverty as well as a constraint to overcoming poverty.”

“Broader interventions that improve the macroeconomic and socioeconomic environment in the country are needed,” Ajay Tandon, the Bank’s senior economist focusing on health-related issues in Laos, said in an interview.

“Many of the determinants of poor maternal health are due to factors outside the health system, (such as) poor road connectivity, poor education, inadequate water and sanitation facilities, as well as low income levels.”